Management of macular holes: A comparison of 1-year outcomes of 3 surgical techniques

Purpose: To evaluate the contribution of internal limiting membrane (ILM) peeling with and without indocyanine green (ICG) to hole closure and functional results in patients with idiopathic macular hole. Methods: Two hundred sixty-four patients with macular hole underwent pars plana vitrectomy. Of the 264, 240 patients completed 1-year follow-up and were divided into three groups: no ILM peeling (84 patients), ILM peeling without ICG (66 patients), and ICG-assisted ILM peeling (90 patients). Results: Macular holes were closed in 87% of the "no peeling" group, in 75% of the ILM peeling without ICG group, and in 92.3% of the ICG-assisted ILM peeling group. Visual acuity improved 2 Snellen lines in all groups (71%, 68%, and 78%, respectively) after successful surgery. In all 3 groups, 20% gained 4 Snellen lines and 14% reached 20/20 vision. There was no statistically significant difference in outcomes among the three groups. Cataract progression was noted more frequently in the ILM peeling groups. No cases of ICG toxicity were recognized. Conclusion: ICG-assisted peeling of the ILM increased macular hole closure rate but was not statistically superior to vitrectomy without membrane peeling. The patients who had ILM peeling without ICG had the least favorable results both anatomically and functionally. The visual gain that was recorded for the majority of the patients after successful macular hole surgery was two Snellen lines.